Provider Demographics
NPI:1124846670
Name:MOSS, WREN (FNP-C)
Entity type:Individual
Prefix:
First Name:WREN
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11888 PLUMB BOB TRL
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-8316
Mailing Address - Country:US
Mailing Address - Phone:660-605-2323
Mailing Address - Fax:
Practice Address - Street 1:600 E ALLEN ST STE A
Practice Address - Street 2:
Practice Address - City:KNOB NOSTER
Practice Address - State:MO
Practice Address - Zip Code:65336-1184
Practice Address - Country:US
Practice Address - Phone:660-563-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024040072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily